| NPI | 1639795180 |
|---|---|
| Former Name | TARA RAQUEL LISTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1018810) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1018810) |
| Enumeration Date | 2020-06-21 |
| Last Update Date | 2022-04-07 |